Measles Symptoms, Diagnosis, and Prevention

A Preventable Cause of Death and Blindness among Children


Measles, also known as “Rubeola,” is a leading cause of death of young children worldwide, despite the availability of an inexpensive and effective vaccine. Over 300 people worldwide - usually children - die per day from a disease we can prevent. Measles-related deaths most frequently occur in developing countries with poor health care systems. But there are more and more cases in the US and Europe due to low vaccination rates.

Prior to introduction of the measles vaccine in 1963, infection during childhood was nearly 100%, causing the measles virus to be named “the most infectious of microbial agents."

Microbe name: Morbillivirus of the Paramyxoviridae family

Type of microbe: RNA Virus

How it causes disease: The measles virus grows in cells that line the back of the throat and lungs. It is spread through the lymphatic system (a system that controls circulating immune cells) throughout the body, causing a systemic viral infection. A person’s antibodies attack the virus, which coincidentally also damages the walls of tiny blood vessels, leading to a rash. The rash can look different on different people. It can cause meningitis and other serious neurologic problems for some people.

How it spreads: Measles is a highly contagious infection spread through coughing and sneezing. Each case can lead to 15 more if people are not vaccinated.

The infection is contagious 4 days before and 4 days after appearance of the measles rash. The virus can live and remain infectious for up to 2 hours on contaminated surfaces, so hand hygiene is very important in prevention. It has been estimated that, in the absence of vaccination or prior infection, all people will get measles at some point in their lives.

Having others be vaccinated protects against the spread of the virus in populations.

Who’s at risk? Anyone who has not been vaccinated.

Symptoms: Symptoms typically first appear about 10 to 12 days after virus exposure. A high fever that lasts 4 to 7 days is accompanied by a runny nose, cough, red, watery eyes, and small white spots inside the cheeks. Between 7 to 18 days after exposure, a rash will appear on the face and neck, spreading downward over a period of 3 days and lasting 5 to 6 days.

Diagnosis: Many diagnoses are made by clinicians who are familiar with the disease. They notice the white spots inside the mouth, fever, and rash, possibly with a runny nose. Diagnosis of measles is most commonly performed by sampling blood for antibodies against the measles virus. Less common methods include detection of the virus or viral DNA, but these techniques have been less reliable and are not routinely used for diagnostic purposes.

Prognosis: The prognosis for measles in healthy children is usually good. However, in developing countries, measles is associated with complications, especially in small children under 5 years who are malnourished and in adults over 20 years. These complications are more common among malnourished individuals and can include blindness, brain infections, and death.

See "complications" below.

Treatment: There are no antiviral medications for treating measles. Treatment includes supportive care, such as good nutrition and lots of fluids to prevent dehydration. Treatment with vitamin A supplements have been shown to reduce measles-related death and blindness and are recommended for malnourished children in developing countries.

Prevention: A live, attenuated measles vaccine became available in 1963 and is combined with vaccines for mumps and rubella (MMR vaccine). When given at 12 to 15 months, the vaccine provides over 90% protection. A second booster dose is recommended prior to entry into kindergarten.

If a child will travel internationally, vaccination is recommended at 6-11 months, followed by the standard 12-15 month vaccine at least 4 weeks later and then another between ages 4 and 6 years.

Complications: Complications of measles are relatively common and include ear infections (~10% infected children), pneumonia (~5%), and brain infections leading to deafness or mental retardation (0.1%). Some of these problems can develop or be noticed well after the infection has passed. Risk for death is ~0.1% to 0.2% worldwide, but up to 25% in developing countries, where malnutrition is a problem. In Africa, measles is the leading cause of blindness in children.

There can be late sequelae like SSPE - Subacute sclerosing panencephalitis which can cause seizures, confusion, and a loss of consciousness followed by death. There is no cure. It is very rare; fewer than 10 case a year. It is a horrible result of measles that develops 7-10 years later on after infection and one for which we cannot do anything to stop once the disease has taken hold, 

There is a concern that there will be more complications if more people are not vaccinated. Outbreaks of measles mean that more are at risk for developing some of the serious side effects. 

This is a disease that could be eradicated, but there continues to be transmission. Vaccination can play an important role in finally stamping out this disease.


Cohen J and Powderly WG. Infectious Diseases, 2nd ed. ©2004 Mosby, An Imprint of Elsevier.

Measles. WHO. Accessed: February 19, 2009.